I have a friend aged 86 who lives with me and is currently in a rehab facility still needing 100% care. Humana has predicted he will be able to leave in a few days from now, which according to his care team is not right. I cannot care for him at the level he needs if he returns home. He has a low income, but does qualify for state assistance due to his assets, which he planned on gifting at his death. We will contest the decision, but I'm afraid we may not win. I could use any advise out there regarding what to do. Does anyone know the rules regarding assets in Minnesota.
Do you have POA? Does anyone have POA? or I should ask is a POA needed?
If he is not progressing with the rehab he is getting any insurance will stop paying for rehab.
It does not matter if he still needs it, if there is no progress it will discontinue.
He needs to talk to the Social Worker and or Discharge Planner and see what help they can be in beginning the process for Medicaid.
If this person is NOT cognizant and no one is POA it is possible that this may have to go to Court and a Court Appointed Guardian will be chosen to make decisions for him.
Appeal Humana's decision immediately and follow the expedited-appeal instructions on the Notice of Medicare Non-Coverage. Ask his doctors, therapists and nursing staff to document why he continues to need skilled care and why returning home isn't safe. However, understand that Medicare rehab coverage and long-term custodial care are two different things. Even if the appeal succeeds, Medicare isn't an indefinite source of payment for 24-hour custodial care.
If he truly requires 24-hour care after rehab, his assets that he intended to leave as an inheritance may instead need to be used for his care. In Minnesota, Medical Assistance has strict financial eligibility rules for elderly people needing long-term care. Don't give away or transfer his assets in an attempt to qualify—Minnesota generally has a five-year look-back for transfers and gifting can create a Medicaid penalty period. Before moving any money, I'd consult a Minnesota elder-law attorney or the county's long-term-care/Medical Assistance office about permissible spend-down options.
Also make it very clear to the facility that you are his friend, not someone capable of providing 24-hour care, and that discharge to your home is not a safe care plan. Ask for a discharge-planning meeting with social work/case management now, rather than waiting until the last covered day.
One additional point: losing Medicare coverage doesn't necessarily mean the facility can simply put him in a car and send him home. It means Medicare/Humana may stop paying for the SNF stay. The facility still has discharge-planning obligations, but somebody has to address how his care will be paid for after Medicare coverage ends. That's why the financial/MA planning needs to start at the same time as the Humana appeal, not afterward.
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One final suggestion: Open Enrollment will start soon. Encourage your friend to use his assets to pay for a Medigap plan, like BCBS Medicare Blue (which is what i have here in MN). Advantage plans are awful when you need actual medical care. Humana is literally the worst. It's the cheapest, that's why it's the worst. You get what you pay for.
He could get a visiting nurse/physical therapy/occupational therapy through his Medicare Humana for a couple days a week for short visits, but that is all that Medicare will pay for once he is no longer covered for rehab. Any additional care will be a private expense.
In case you aren't familiar with AFC homes, these are facilities that are usually actual homes that have been renovated to accommodate between 5-20 residents with shared or private rooms and common kitchen/living room/etc. There are caregivers in the home (not usually nurses) that provide help with activities of daily living, meals, giving him medications, etc. This option tends to be more affordable than paying out of pocket at a nursing home or assisted living, but it is still likely a few thousand dollars a month. Best of luck to you in helping your friend!